Tourette syndrome: treatment

Howard Kushner, one of the greatest historians on Tourette syndrome (TS) did an important review on the history of TS which served as the basis for this introduction (see Kushner, 1999, for review). He performed detailed research in which he personally translated several French documents, including the first article by Gilles de la Tourette, published in 1885 and which reports a case series of patients who presented a combination of multiple motor tics and “involuntary” vocalizations with the eventual appearance of eruptive cursing that he designated “coprolalia” (Tourette, 1885). Gilles de la Tourette labeled this disorder maladie des tics convulsifs avec coprolalie, insisting that it was distinct from choreas and hysterias. Based on nine patients’ case histories, Gilles de la Tourette concluded that, although its signs and symptoms might wax and wane, the disease ultimately resisted all interventions (Kushner, 1999). Many theories were postulated to explain the origin of this strange disease, such as psychologic (a type of hysteria), degenerative, infectious (a type of chorea, or rheumatic fever, or secondary to encephalitis), and hereditary. As a result, patients with similar medical histories and symptoms received different treatments depending on the philosophy and training of their particular physicians (Kushner and Howard, 2000).